The Value of Clinical, Laboratory and Brain CT Scan Findings in Methanol Toxicity
-
Leila Etemad
,
AmirAli Moodi Ghalibaf
,
Ali Sadr
,
Masoud Pezeshki Rad
,
Majid Khadem-Rezaiyan
,
Amir Behforouz
,
Setareh Azarkar
,
Asieh Karimani
,
Hossein Ghaffari
,
Mohammad Moshiri
Abstract
Methanol poisoning is a severe intoxication that can be fatal. This study aimed to determine the association between clinical and paraclinical findings, particularly brain radiological findings, and the risk of mortality in methanol-poisoned patients. This retrospective cross-sectional study was conducted at the CTD-IRH-MUMS, Mashhad, Iran, from March 2019 to March 2021. Medical and demographic data of adult patients with a confirmed diagnosis of methanol poisoning who had undergone a brain computed tomography (CT) scan were included. A total of 45 methanol-poisoned patients were enrolled in the study, including 36 men (80%) with a mean age of 34.32±13.20 years. Among them, 15 patients (33.3%) had at least one abnormal finding on their brain CT scans. The most frequent finding was diffuse cerebral hemorrhage (n=12, 26.7%), followed by subcortical white matter changes (n=9, 20%), and putaminal hypodensities (n=7, 15.6%). Although abnormal brain CT findings were associated with a higher risk of mortality (OR=4.929, P=0.019), they were not related to any specific type of CT findings. A Glasgow Coma Scale (GCS) score<9 (OR=0.445, P=0.003), respiratory rate>19 breaths/min (OR=2.675, P=0.006), serum creatinine level>1.8 mg/dL (OR=6.258, P=0.009), potassium level>4.3 mEq/L (OR=3.672, P=0.006), glucose level (OR=1.011, P=0.019), bicarbonate level<11.4 mEq/L (OR=0.872, P=0.003), and pH<7.11 (OR=0.001, P=0.003) were predictors of mortality with acceptable sensitivity and specificity. Lower GCS, PCO2, and HCO3 levels, along with higher blood pressure, were associated with a higher incidence of pathological brain CT findings. Physicians should consider acidosis, tachypnea, decreased consciousness, and elevated blood glucose and creatinine levels as predictors of mortality or pathological brain CT findings.
1. Blug M, Leker J, Plass L, Günther A. Methanol generation economics. In: Methanol: The basic chemical and energy feedstock of the future. Springer; 2014:603-18.
2. Kraut JA. Approach to the treatment of methanol intoxication. Am J Kidney Dis 2016;68:161-7.
3. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA, American Academy of Clinical Toxicology Ad Hoc Committee on the Treatment Guidelines for Methanol Poisoning. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol 2002;40:415-46.
4. Lushine KA, Harris CR, Holger JS. Methanol ingestion: prevention of toxic sequelae after massive ingestion. J Emerg Med 2003;24:433-6.
5. Eghbali H, Mostafazadeh B, Ghorbani M, Behnoush B. Neurologic complications of methanol poisoning: a clinicoepidemiological report from poisoning treatment centers in Tehran, Iran. Asia Pac J Med Toxicol 2015;4:47-50.
6. Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. Methanol outbreak in Norway 2002-2004: epidemiology, clinical features and prognostic signs. J Intern Med 2005;258:181-90.
7. Shadnia S, Rahimi M, Soltaninejad K, Nilli A. Role of clinical and paraclinical manifestations of methanol poisoning in outcome prediction. J Res Med Sci 2013;18:865-9.
8. Mahdavi SA, Zamani N, McDonald R, Akhgari M, Kolahi AA, Gheshlaghi F, et al. A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic. Sci Rep 2022;12:9741.
9. Mehrpour O, Sadeghi M. Toll of acute methanol poisoning for preventing COVID-19. Arch Toxicol 2020;94:2259-60.
10. Mostafazadeh B, Eghbali H. An epidemiologic study on methyl alcohol poisoning in Tehran, Iran. Asia Pac J Med Toxicol 2014;3:8.
11. Shokoohi M, Nasiri N, Sharifi H, Baral S, Stranges S. A syndemic of COVID-19 and methanol poisoning in Iran: time for Iran to consider alcohol use as a public health challenge? Alcohol 2020;87:25-7.
12. Mahdavi SA, Kolahi AA, Akhgari M, Gheshlaghi F, Gholami N, Moshiri M, et al. COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: a data linkage study. Alcohol Clin Exp Res 2021;45:1853-63.
13. Ahmed F, Khan NU, Ali N, Feroze A. Methanol poisoning: 27 years experience at a tertiary care hospital. J Pak Med Assoc 2017;67:1751-2.
14. Mousavi SR, Dadpour B, Moshiri M, Moghiman T, Khosrojerdi H, Najari F. Methanol poisoning as a trigger for the presentation of diabetes mellitus: a case report. Int J Med Toxicol Forensic Med 2019;9:151-4.
15. Camurcuoglu E, Halefoglu AM. CT and MR imaging findings in methanol intoxication manifesting with bilateral severe basal ganglia and cerebral involvement. J Belg Soc Radiol 2022;106:66.
16. Taheri MS, Moghaddam HH, Moharamzad Y, Dadgari S, Nahvi V. The value of brain CT findings in acute methanol toxicity. Eur J Radiol 2010;73:211-4.
17. Bessell-Browne R, Bynevelt M. Two cases of methanol poisoning: CT and MRI features. Australas Radiol 2007;51:175-8.
18. Kim HJ, Na JY, Lee YJ, Park JT, Kim HS. An autopsy case of methanol induced intracranial hemorrhage. Int J Clin Exp Pathol 2015;8:13643-6.
19. Hassanian-Moghaddam H, Bahrami-Motlagh H, Zamani N, Fazeli SA, Behnam B. Intracranial hemorrhage in methanol toxicity: challenging the probable heparin effect during hemodialysis. J Res Pharm Pract 2017;6:186-9.
20. Sohor NJ, Loh WC, Pang RY, Khan AH, Chia PK, Sulaiman WAW, et al. Spontaneous bilateral basal ganglia haemorrhage secondary to methanol poisoning. Neurol India 2023;71:1260-2.
21. Arora V, Nijjar IB, Multani AS, Singh JP, Abrol R, Chopra R, et al. MRI findings in methanol intoxication: a report of two cases. Br J Radiol 2007;80:e243-6.
22. Simani L, Ramezani M, Roozbeh M, Shadnia S, Pakdaman H. The outbreak of methanol intoxication during COVID-19 pandemic: prevalence of brain lesions and its predisposing factors. Drug Chem Toxicol 2022;45:1500-3.
23. Nekoukar Z, Zakariaei Z, Taghizadeh F, Musavi F, Banimostafavi ES, Sharifpour A, et al. Methanol poisoning as a new world challenge: a review. Ann Med Surg (Lond) 2021;66:102445.
24. Sharma R, Marasini S, Sharma AK, Shrestha JK, Nepal BP. Methanol poisoning: ocular and neurological manifestations. Optom Vis Sci 2012;89:178-82.
25. Koehrer P, Creuzot-Garcher C, Bron AM. Methanol poisoning: two case studies of blindness in Indonesia. Int Ophthalmol 2011;31:517-24.
26. Grzybowski A, Zulsdorff M, Wilhelm H, Tonagel F. Toxic optic neuropathies: an updated review. Acta Ophthalmol 2015;93:402-10.
27. Baj J, Forma A, Kobak J, Tyczyńska M, Dudek I, Maani A, et al. Toxic and nutritional optic neuropathies: an updated mini-review. Int J Environ Res Public Health 2022;19.
28. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes: a multicenter study. Clin Toxicol (Phila) 2012;50:823-31.
29. Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, Shadnia S. Prognostic factors in methanol poisoning. Hum Exp Toxicol 2007;26:583-6.
30. Yousefinejad V, Moradi B, Mohammadi Baneh A, Sheikhesmaeili F, Babahajian A. Prognostic factors of outcome in methanol poisoning: an 8-year retrospective cross-sectional study. Arch Acad Emerg Med 2020;8:e69.
31. Sanaei-Zadeh H, Kazemi Esfeh S, Zamani N, Jamshidi F, Shadnia S. Hyperglycemia is a strong prognostic factor of lethality in methanol poisoning. J Med Toxicol 2011;7:189-94.
32. Zakharov S, Kotikova K, Vaneckova M, Seidl Z, Nurieva O, Navratil T, et al. Acute methanol poisoning: prevalence and predisposing factors of haemorrhagic and non-haemorrhagic brain lesions. Basic Clin Pharmacol Toxicol. 2016;119:228-38.
33. Kerns W 2nd, Tomaszewski C, McMartin K, Ford M, Brent J, Alcohols Study Group, Multicenter Methanol Treatment Trial. Formate kinetics in methanol poisoning. J Toxicol Clin Toxicol 2002;40:137-43.
34. Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila) 2007;45:152-7.
35. Hovda KE, Hunderi OH, Rudberg N, Froyshov S, Jacobsen D. Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients. Intensive Care Med 2004;30:1842-6.
36. Kubáň P, Foret F, Bocek R. Capillary electrophoresis with contactless conductometric detection for rapid screening of formate in blood serum after methanol intoxication. J Chromatogr A 2013;1281:142-7.
37. Lachance P, Mac-Way F, Desmeules S, De Serres SA, Julien AS, Douville P, et al. Prediction and validation of hemodialysis duration in acute methanol poisoning. Kidney Int 2015;88:1170-7.
38. Kaewput W, Thongprayoon C, Petnak T, Chewcharat A, Boonpheng B, Bathini T, et al. Inpatient burden and mortality of methanol intoxication in the United States. Am J Med Sci 2021;361:69-74.
39. Sefidbakht S, Rasekhi AR, Kamali K, Borhani Haghighi A, Salooti A, Meshksar A, et al. Methanol poisoning: acute MR and CT findings in nine patients. Neuroradiology 2007;49:427-35.
40. Vaneckova M, Zakharov S, Klempir J, Ruzicka E, Bezdicek O, Brozova H, et al. Imaging findings after methanol intoxication (cohort of 46 patients). Neuro Endocrinol Lett 2015;36:737-44.
41. Anderson JC, Costantino MM, Stratford T. Basal ganglia: anatomy, pathology, and imaging characteristics. Curr Probl Diagn Radiol 2004;33:28-41.
42. Mana J, Vaneckova M, Klempíř J, Lišková I, Brožová H, Poláková K, et al. Methanol poisoning as an acute toxicological basal ganglia lesion model: evidence from brain volumetry and cognition. Alcohol Clin Exp Res 2019;43:1486-97.
43. Çomoğlu S, Özen B, Özbakır Ş. Methanol intoxication with bilateral basal ganglia infarct. Australas Radiol 2001;45:357-8.
44. Sanaei-Zadeh H. Typical bilateral putaminal lesions of methanol intoxication. J Emerg Med. 2012;42(2):178-9.
45. Dujardin M, Peeters E, Ernst C, Stadnik T. Bilateral putaminal necrosis due to methanol abuse. JBR BTR 2006;89:316.
46. Tanrivermis Sayit A, Aslan K, Elmali M, Gungor I. Methanol-induced toxic optic neuropathy with diffusion weighted MRI findings. Cutan Ocul Toxicol 2016;35:337-40.
2. Kraut JA. Approach to the treatment of methanol intoxication. Am J Kidney Dis 2016;68:161-7.
3. Barceloux DG, Bond GR, Krenzelok EP, Cooper H, Vale JA, American Academy of Clinical Toxicology Ad Hoc Committee on the Treatment Guidelines for Methanol Poisoning. American Academy of Clinical Toxicology practice guidelines on the treatment of methanol poisoning. J Toxicol Clin Toxicol 2002;40:415-46.
4. Lushine KA, Harris CR, Holger JS. Methanol ingestion: prevention of toxic sequelae after massive ingestion. J Emerg Med 2003;24:433-6.
5. Eghbali H, Mostafazadeh B, Ghorbani M, Behnoush B. Neurologic complications of methanol poisoning: a clinicoepidemiological report from poisoning treatment centers in Tehran, Iran. Asia Pac J Med Toxicol 2015;4:47-50.
6. Hovda KE, Hunderi OH, Tafjord AB, Dunlop O, Rudberg N, Jacobsen D. Methanol outbreak in Norway 2002-2004: epidemiology, clinical features and prognostic signs. J Intern Med 2005;258:181-90.
7. Shadnia S, Rahimi M, Soltaninejad K, Nilli A. Role of clinical and paraclinical manifestations of methanol poisoning in outcome prediction. J Res Med Sci 2013;18:865-9.
8. Mahdavi SA, Zamani N, McDonald R, Akhgari M, Kolahi AA, Gheshlaghi F, et al. A cross-sectional multicenter linkage study of hospital admissions and mortality due to methanol poisoning in Iranian adults during the COVID-19 pandemic. Sci Rep 2022;12:9741.
9. Mehrpour O, Sadeghi M. Toll of acute methanol poisoning for preventing COVID-19. Arch Toxicol 2020;94:2259-60.
10. Mostafazadeh B, Eghbali H. An epidemiologic study on methyl alcohol poisoning in Tehran, Iran. Asia Pac J Med Toxicol 2014;3:8.
11. Shokoohi M, Nasiri N, Sharifi H, Baral S, Stranges S. A syndemic of COVID-19 and methanol poisoning in Iran: time for Iran to consider alcohol use as a public health challenge? Alcohol 2020;87:25-7.
12. Mahdavi SA, Kolahi AA, Akhgari M, Gheshlaghi F, Gholami N, Moshiri M, et al. COVID-19 pandemic and methanol poisoning outbreak in Iranian children and adolescents: a data linkage study. Alcohol Clin Exp Res 2021;45:1853-63.
13. Ahmed F, Khan NU, Ali N, Feroze A. Methanol poisoning: 27 years experience at a tertiary care hospital. J Pak Med Assoc 2017;67:1751-2.
14. Mousavi SR, Dadpour B, Moshiri M, Moghiman T, Khosrojerdi H, Najari F. Methanol poisoning as a trigger for the presentation of diabetes mellitus: a case report. Int J Med Toxicol Forensic Med 2019;9:151-4.
15. Camurcuoglu E, Halefoglu AM. CT and MR imaging findings in methanol intoxication manifesting with bilateral severe basal ganglia and cerebral involvement. J Belg Soc Radiol 2022;106:66.
16. Taheri MS, Moghaddam HH, Moharamzad Y, Dadgari S, Nahvi V. The value of brain CT findings in acute methanol toxicity. Eur J Radiol 2010;73:211-4.
17. Bessell-Browne R, Bynevelt M. Two cases of methanol poisoning: CT and MRI features. Australas Radiol 2007;51:175-8.
18. Kim HJ, Na JY, Lee YJ, Park JT, Kim HS. An autopsy case of methanol induced intracranial hemorrhage. Int J Clin Exp Pathol 2015;8:13643-6.
19. Hassanian-Moghaddam H, Bahrami-Motlagh H, Zamani N, Fazeli SA, Behnam B. Intracranial hemorrhage in methanol toxicity: challenging the probable heparin effect during hemodialysis. J Res Pharm Pract 2017;6:186-9.
20. Sohor NJ, Loh WC, Pang RY, Khan AH, Chia PK, Sulaiman WAW, et al. Spontaneous bilateral basal ganglia haemorrhage secondary to methanol poisoning. Neurol India 2023;71:1260-2.
21. Arora V, Nijjar IB, Multani AS, Singh JP, Abrol R, Chopra R, et al. MRI findings in methanol intoxication: a report of two cases. Br J Radiol 2007;80:e243-6.
22. Simani L, Ramezani M, Roozbeh M, Shadnia S, Pakdaman H. The outbreak of methanol intoxication during COVID-19 pandemic: prevalence of brain lesions and its predisposing factors. Drug Chem Toxicol 2022;45:1500-3.
23. Nekoukar Z, Zakariaei Z, Taghizadeh F, Musavi F, Banimostafavi ES, Sharifpour A, et al. Methanol poisoning as a new world challenge: a review. Ann Med Surg (Lond) 2021;66:102445.
24. Sharma R, Marasini S, Sharma AK, Shrestha JK, Nepal BP. Methanol poisoning: ocular and neurological manifestations. Optom Vis Sci 2012;89:178-82.
25. Koehrer P, Creuzot-Garcher C, Bron AM. Methanol poisoning: two case studies of blindness in Indonesia. Int Ophthalmol 2011;31:517-24.
26. Grzybowski A, Zulsdorff M, Wilhelm H, Tonagel F. Toxic optic neuropathies: an updated review. Acta Ophthalmol 2015;93:402-10.
27. Baj J, Forma A, Kobak J, Tyczyńska M, Dudek I, Maani A, et al. Toxic and nutritional optic neuropathies: an updated mini-review. Int J Environ Res Public Health 2022;19.
28. Paasma R, Hovda KE, Hassanian-Moghaddam H, Brahmi N, Afshari R, Sandvik L, et al. Risk factors related to poor outcome after methanol poisoning and the relation between outcome and antidotes: a multicenter study. Clin Toxicol (Phila) 2012;50:823-31.
29. Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, Shadnia S. Prognostic factors in methanol poisoning. Hum Exp Toxicol 2007;26:583-6.
30. Yousefinejad V, Moradi B, Mohammadi Baneh A, Sheikhesmaeili F, Babahajian A. Prognostic factors of outcome in methanol poisoning: an 8-year retrospective cross-sectional study. Arch Acad Emerg Med 2020;8:e69.
31. Sanaei-Zadeh H, Kazemi Esfeh S, Zamani N, Jamshidi F, Shadnia S. Hyperglycemia is a strong prognostic factor of lethality in methanol poisoning. J Med Toxicol 2011;7:189-94.
32. Zakharov S, Kotikova K, Vaneckova M, Seidl Z, Nurieva O, Navratil T, et al. Acute methanol poisoning: prevalence and predisposing factors of haemorrhagic and non-haemorrhagic brain lesions. Basic Clin Pharmacol Toxicol. 2016;119:228-38.
33. Kerns W 2nd, Tomaszewski C, McMartin K, Ford M, Brent J, Alcohols Study Group, Multicenter Methanol Treatment Trial. Formate kinetics in methanol poisoning. J Toxicol Clin Toxicol 2002;40:137-43.
34. Paasma R, Hovda KE, Tikkerberi A, Jacobsen D. Methanol mass poisoning in Estonia: outbreak in 154 patients. Clin Toxicol (Phila) 2007;45:152-7.
35. Hovda KE, Hunderi OH, Rudberg N, Froyshov S, Jacobsen D. Anion and osmolal gaps in the diagnosis of methanol poisoning: clinical study in 28 patients. Intensive Care Med 2004;30:1842-6.
36. Kubáň P, Foret F, Bocek R. Capillary electrophoresis with contactless conductometric detection for rapid screening of formate in blood serum after methanol intoxication. J Chromatogr A 2013;1281:142-7.
37. Lachance P, Mac-Way F, Desmeules S, De Serres SA, Julien AS, Douville P, et al. Prediction and validation of hemodialysis duration in acute methanol poisoning. Kidney Int 2015;88:1170-7.
38. Kaewput W, Thongprayoon C, Petnak T, Chewcharat A, Boonpheng B, Bathini T, et al. Inpatient burden and mortality of methanol intoxication in the United States. Am J Med Sci 2021;361:69-74.
39. Sefidbakht S, Rasekhi AR, Kamali K, Borhani Haghighi A, Salooti A, Meshksar A, et al. Methanol poisoning: acute MR and CT findings in nine patients. Neuroradiology 2007;49:427-35.
40. Vaneckova M, Zakharov S, Klempir J, Ruzicka E, Bezdicek O, Brozova H, et al. Imaging findings after methanol intoxication (cohort of 46 patients). Neuro Endocrinol Lett 2015;36:737-44.
41. Anderson JC, Costantino MM, Stratford T. Basal ganglia: anatomy, pathology, and imaging characteristics. Curr Probl Diagn Radiol 2004;33:28-41.
42. Mana J, Vaneckova M, Klempíř J, Lišková I, Brožová H, Poláková K, et al. Methanol poisoning as an acute toxicological basal ganglia lesion model: evidence from brain volumetry and cognition. Alcohol Clin Exp Res 2019;43:1486-97.
43. Çomoğlu S, Özen B, Özbakır Ş. Methanol intoxication with bilateral basal ganglia infarct. Australas Radiol 2001;45:357-8.
44. Sanaei-Zadeh H. Typical bilateral putaminal lesions of methanol intoxication. J Emerg Med. 2012;42(2):178-9.
45. Dujardin M, Peeters E, Ernst C, Stadnik T. Bilateral putaminal necrosis due to methanol abuse. JBR BTR 2006;89:316.
46. Tanrivermis Sayit A, Aslan K, Elmali M, Gungor I. Methanol-induced toxic optic neuropathy with diffusion weighted MRI findings. Cutan Ocul Toxicol 2016;35:337-40.
| Files | ||
| Issue | Vol 64 No 7 (2026) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/acta.v64i7.22415 | |
| Keywords | ||
| Methanol Poisoning CT scan Sensitivity and specificity Mortality | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Etemad L, Moodi Ghalibaf A, Sadr A, Pezeshki Rad M, Khadem-Rezaiyan M, Behforouz A, Azarkar S, Karimani A, Ghaffari H, Moshiri M. The Value of Clinical, Laboratory and Brain CT Scan Findings in Methanol Toxicity. Acta Med Iran. 2026;64(7):410-421.
